Mobile Healthcare Executive Briefing From Informa Tm

STRATEGIC REPORT & FORECASTS

Executive summary Mobile Healthcare: Markets and Trends for M-health Applications

Worldwide Market Analysis and Strategic Outlook

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Mobile Healthcare: Markets and Trends for M-health Applications Mobile Healthcare: Markets and Trends for M-health Applications assesses current and future implications of m-health across global markets. It reviews a whole spectrum of possible m-health products and services and analyses what is driving these to commercial deployment. The report gives in-depth consideration to the procedural, technological and regulatory barriers that must be overcome for market potential to be realised.

The Mobile Healthcare report is essential for: Mobile operators: • Identify where the potential opportunities to drive revenue exist • Find out who key players are and where successful partnerships may lie Device and component vendors: • Understand what new technologies are emerging and which to pursue • Identify who to partner with • Find out the potential market size and who is driving demand Healthcare professionals, pharmaceutical companies and government health and regulatory departments: • Find out how m-health can improve efficiency and health outcomes • Identify key suppliers and who is innovating where • Understand the issues that must be overcome for deployment

“

The use of mobile communications to support health services is a growing global trend. M-health - as it is commonly referred to - promises cost-efficiencies and improved health outcomes with a dizzying array of services beyond the humble appointment reminder. The explosion of mobile broadband and the promise of high data speeds with LTE make high bandwidth applications for remote monitoring and diagnosis an exciting value proposition.

”

Philippa Hobbs, Business Research Executive, Informa Telecoms & Media

For more information visit www.informatm.com/mobilehealth © 2009 Informa UK Ltd. All rights reserved. The contents of this publication are protected by international copyright laws, database rights and other intellectual property rights. The owner of these rights is Informa UK Ltd, our affiliates or other third party licensors. All product and company names and logos contained within or appearing on this publication are the trade marks, service marks or trading names of their respective owners, including Informa UK Ltd. This publication may not be:(a) copied or reproduced; or (b) lent, resold, hired out or otherwise circulated in any way or form without the prior permission of Informa UK Ltd. Whilst reasonable efforts have been made to ensure that the information and content of this publication was correct as at the date of first publication, neither Informa UK Ltd nor any person engaged or employed by Informa UK Ltd accepts any liability for any errors, omissions or other inaccuracies. Readers should independently verify any facts and figures as no liability can be accepted in this regard - readers assume full responsibility and risk accordingly for their use of such information and content. Any views and/or opinions expressed in this publication by individual authors or contributors are their personal views and/or opinions and do not necessarily reflect the views and/or opinions of Informa UK Ltd.

MOBILE HEALTHCARE: MARKETS AND TRENDS FOR M-HEALTH APPLICATIONS

Chapter 1

Executive summary Mobile healthcare: what and why? Mobile healthcare is a relatively new term in telecoms. Often referred to as m-health, it is used to describe a myriad of mobile services and wireless technologies designed specifically for use in the provision of healthcare. The majority of the m-health market currently sits within the enterprise segment, although the number of consumer-targeted health and wellness applications is on the rise. Activity in the mobile healthcare space grew considerably in 2008, shown by the particular focus placed on mobile healthcare at the Mobile World Congress 2009. The expansion of HSPA networks with the explosion of mobile data demands, the growth of mobile broadband and the promise of even higher speeds with LTE mean that deploying advanced applications requiring higher data capacity on a wide scale is becoming increasingly viable. A number of major network operators offer services to the healthcare industry; healthcare organizations have been corporate customers of the operators for many years. Pressure on health systems to manage resources better has created a valid market need for applications which increase operational efficiency within healthcare organizations. The majority of deployed services are basic enterprise telecommunications for communication or information transfer with a particular customization for use within a healthcare organization; this customization might include features such as guaranteed network coverage for emergency services and security features to protect sensitive clinical data. To support functions that relate more directly to the process of healthcare provision, M2M services such as tracking, tagging and remote patient monitoring are key emerging trends. The EU is investing more public funds in this area – notably into remote monitoring and the development of ‘intelligent environments’ using wireless sensor networks, and innovation in the private sector is growing, but the market remains largely untapped while barriers to market persist. There is a potential value proposition in monitoring services with medical devices connected wirelessly to handsets. These services and devices could be either outsourced to monitoring companies, or perhaps self-managed by mobile consumers enabled with data analysis software supported on their own handsets by advanced operating systems. Data collection is already possible on a basic level, on smartphones which can track activity levels via GPS. Applications for measuring distance run, counting calories, encouraging smoking cessation and collecting basic vital signs are growing in number and suggest a rising trend in self-monitoring and a potential readiness to accept medical monitoring among the target patient population with extra devices such as sensors.

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CHAPTER 1

MOBILE HEALTHCARE: MARKETS AND TRENDS FOR M-HEALTH APPLICATIONS

Increased penetration of consumer handsets with functionalities such as Bluetooth and GPS, the explosion of smartphones with enhanced usability and the growth of enhanced networks with high data capacities are key enablers for the deployment of connectable monitoring devices. The proliferation of high data speeds for mobile devices will drive the commercial viability of advanced applications such as remote patient monitoring, which requires high-speed transfer of clinical data. Humanitarian foundations and telecoms players have also identified m-health as a way to use existing mobile networks to bring health services and information to a large number of people otherwise unable to access healthcare.

The healthcare sector as a target enterprise market for mobile operators Global health trends are indicating a need for urgent change in healthcare provision: global healthcare expenditure is rising and in some countries is becoming unsustainable. The rise in chronic illnesses, such as diabetes, heart diseases and pulmonary diseases, caused by lifestyle diseases, such as obesity and aging populations, is placing unprecedented long-term pressure on health systems. The healthcare market is not a straightforward enterprise segment, like the retail or automotive industries. It is wide-reaching and diverse, made up of a variety of different types of healthcare organizations which may control between one and several hundred healthcare providers. As an enterprise segment, it must be considered in the context of the healthcare system of the market in which it may be found, as this determines its funding structure. Most healthcare systems combine both public and privately funded healthcare provision in varying degrees. Extreme cases of each – the UK with its predominantly public system based on the National Health Service (NHS), the US with its heavily private model based mostly on a corporate structure, and low-income African countries with unstructured care provision – reveal differences in m-health barriers, opportunities and emerging trends. In the UK, for example, modernization of the public sector is slow, and even basic mobile communications are not fully deployed across the NHS nationwide. Public sector procedural, logistical and political barriers stand in the way of adoption of advanced mobile services. A need for more efficient communications systems has been highlighted by several instances of public sector data loss, as well as the sometimes fatal consequences of a lack of information transfer between care organizations. In the US, the healthcare market is under pressure to reform its systems to cope with health trends and depleted resources and fully integrated health IT continues to be stalled by a lack of infrastructure. Operators have offered mobile enterprise services for some time, however, and telecoms players as well as third-party organizations are now spearheading industry collaboration in mobile healthcare innovation.

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MOBILE HEALTHCARE: MARKETS AND TRENDS FOR M-HEALTH APPLICATIONS

By contrast, in low-income African countries such as the Democratic Republic of Congo, healthcare provision is unregulated and treatment has become commoditized – health workers offer services for high fees in people’s homes in addition to their daily work. However, in these regions, access to mobile services is widespread and growing and the potential for mobile healthcare services to fulfill a desperate need is quite different. M-health is increasingly seen as a tool to bring healthcare to communities which lack primary care provision and education with information and surveillance applications.

Key barriers to the mobile healthcare market Rolling out mobile healthcare services within healthcare organizations may be a slower process than it usually is for enterprise services, because ‘business as usual’ must be maintained throughout the adoption process and delays in rollout will be inevitable as clinical safety remains paramount. Services must be effective from day one at the grass roots level to minimize churn; cash-strapped health administrations will be looking for even minimal reticence from the users as an excuse to halt services and save costs. Ultimately, there must be a valid need or a valid financial incentive for clinical users to adopt new systems and allow the disruption of their existing systems. For advanced mobile healthcare applications, costs are a key barrier. The high power consumption of wireless technologies such as Bluetooth is a barrier to bringing M2M healthcare products to market. Low-energy technologies are emerging but they are costly. The most significant barrier to a scalable deployment of mobile healthcare services is probably market fragmentation. Application developers and vendors themselves are fragmented, offering applications based on their particular field of expertise. Mobile technology is fragmented, with a number of applications restricted to particular platforms, high-range handsets or specialist devices. The end-user healthcare market is structurally fragmented, with private, public and unprovided health systems innovating at different paces, and healthcare professionals requiring simplified adoption processes to ensure business can proceed as usual.

Summary conclusions In the case of the UK’s NHS, the amount of financial loss caused by problems that can be solved by mobile solutions points to m-health as a viable market to invest in, and this fact is now recognized by the country’s Department of Health. However, implementation must be backed up with adjusted payment structures; for example, clinicians must be incentivized to provide remote care provision, but financial incentives for surgeries to innovate are non-existent and clinicians are remunerated only for face to face treatment.

© Informa UK Limited 2009. All rights reserved.

CHAPTER 1

CHAPTER 1

MOBILE HEALTHCARE: MARKETS AND TRENDS FOR M-HEALTH APPLICATIONS

The market for the biggest emerging trend – remote monitoring technology – is dictated not by the target market – health administrators – but the patients. However, many of the patients are likely to be unfamiliar with mobile technology; when financial hurdles and the risk of loss and damage are overcome, this factor may well be m-health’s biggest long-term hurdle. Patients will need considerable training and support, and clinics must be incentivized to meet this extra burden. Additionally, any strategy which could be seen as a veiled attempt to remove or reduce clinicians or carers is highly politically sensitive. Similar challenges are faced in the US, despite it having a different healthcare system from the UK. The healthcare system itself is considered a contributory factor to declining health trends in the US with its inequitable access to medical services and subsidized private health insurance. In addition, the system also must meet the challenge of a growing need for care. A shift towards the promotion of wellness and self-care via patient engagement – a key part of the hot industry topic of ‘personalized care’ Health 2.0 – is gaining significant traction among healthcare organizations and insurers looking to improve their business model, and the government looking to reform healthcare provision. This presents a potential long-term opportunity for the mobile industry to penetrate the healthcare enterprise market beyond just connected workforces to connected workforces and patients. But innovation is fragmented and the question of who foots the bill for monitoring devices remains unresolved. As for emerging markets, operators stand to gain from developing brand loyalty by deploying services to these countries as future potential mobile market growth is a stronger proposition there than it is in mature markets. Across all markets, there are clear opportunities for customized mobile voice and data services. These are already being exploited by some mobile network operators, but operators must highlight the cost-efficiencies of their services as a key selling point whether it is a long-term saving or a capex saving on a must-have service. There are also opportunities for more advanced mobile uses in clinical environments, which could be exploited with the emergence of multi-standard chipsets and low-energy wireless technology at commercially viable prices, and high network capacity. Fragmentation in innovation, technology and the end-user market is preventing scalable deployment of m-health applications. Application providers include a variety of technology and healthcare players, predominantly in the US, that largely develop services based on their own field of expertise – and a wide-ranging customer base is faced with a complex choice of services dependent on different devices, platforms and service providers. The two industries of mobile communications and healthcare with their specialized technical expertise should be able to converge effectively, as long as the short-term benefits are discernable at grass roots level beyond improved health outcomes.

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Contents CHAPTER 1 EXECUTIVE SUMMARY ...............1 Mobile healthcare: what and why? . . . . . . . . . . . . . 1 The healthcare sector as a target enterprise market for mobile operators . . . . . . . . . . . . . . . . . . 2 Key barriers to the mobile healthcare market . . . . . 3 Summary conclusions . . . . . . . . . . . . . . . . . . . . . . 3

CHAPTER 4 M-HEALTH CONTENT AND A P P L I C A T I O N S T R E N D S . . . . . . . . . . . . 27 Key points . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Market status . . . . . . . . . . . . . . . . . . . . . . . . . 27 General categories and trends . . . . . . . . . . . . . . . 27 Figure 4.1: M-health application categories . . 28

Deployment trends . . . . . . . . . . . . . . . . . . . . . . . 28 CHAPTER 2 MOBILE HEALTHCARE ECOSYSTEM .5 Defining terms . . . . . . . . . . . . . . . . . . . . . . . . . . 5 What is mobile healthcare? . . . . . . . . . . . . . . . . . . 5

Figure 4.2: M-health applications: geographical trends. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Key players . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Figure 2.1: Principal m-health categories . . . . . 6

Information/communication m-health applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 General overview . . . . . . . . . . . . . . . . . . . . . 30 Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Monitoring m-health applications . . . . . . . . . . . . 31 General overview. . . . . . . . . . . . . . . . . . . . . . 31 Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Surveillance m-health applications . . . . . . . . . . . 33 General overview. . . . . . . . . . . . . . . . . . . . . . 33 Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Diagnostic m-health applications . . . . . . . . . . . . 34 General overview . . . . . . . . . . . . . . . . . . . . . 34 Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Market drivers . . . . . . . . . . . . . . . . . . . . . . . . 34 Market barriers . . . . . . . . . . . . . . . . . . . . . . . . 35 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Trends in mobile healthcare. . . . . . . . . . . . . . . . . . 6 General conclusions . . . . . . . . . . . . . . . . . . . . . . . 7 Global operator trends . . . . . . . . . . . . . . . . . . . 8 Emerging trends . . . . . . . . . . . . . . . . . . . . . . . . . 8 General conclusions . . . . . . . . . . . . . . . . . . . . . . . 8 Content and applications . . . . . . . . . . . . . . . . 8 Emerging trends . . . . . . . . . . . . . . . . . . . . . . . . . . 8 General conclusions . . . . . . . . . . . . . . . . . . . . . . . 9 Mobile devices and technology . . . . . . . . . . 9 Emerging trends . . . . . . . . . . . . . . . . . . . . . . . . . . 9 General conclusions . . . . . . . . . . . . . . . . . . . . . . . 9 Mobile healthcare value chain. . . . . . . . . . . 10 Figure 2.2: Mobile healthcare value chain . . . 10 Figure 2.3: Examples of members of the mobile healthcare value chain . . . . . . . . . . . . . . . . . 11

CHAPTER 3 GLOBAL MOBILE OPERATOR T R E N D S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Key points . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Market status . . . . . . . . . . . . . . . . . . . . . . . . . 15 Vodafone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 France Telecom . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Telefonica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Telecom Italia . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Sprint Nextel . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Verizon Wireless . . . . . . . . . . . . . . . . . . . . . . . . . 19 AT&T Mobility . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Bharti Airtel . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 SingTel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Telstra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Market drivers . . . . . . . . . . . . . . . . . . . . . . . . 22 Market barriers . . . . . . . . . . . . . . . . . . . . . . . . 23 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

CHAPTER 5 M-HEALTH DEVICES AND T E C H N O L O G Y . . . . . . . . . . . . . . . . . . . . . . . 39 Key points . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Market status . . . . . . . . . . . . . . . . . . . . . . . . . 39 Figure 5.1: M-health device types . . . . . . . . . 39

Market size for monitoring devices . . . . . . . . . . . . 41 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Figure 5.2: Devices and technologies used in m-health, by location where used . . . . . . . . . 42 In the hospital . . . . . . . . . . . . . . . . . . . . . . . . . . 42 In the field . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 In the home . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Figure 5.3: Telefonica Sensor Network Infrastructure . . . . . . . . . . . . . . . . . . . . . . . 44 Market drivers . . . . . . . . . . . . . . . . . . . . . . . . 45 Market barriers . . . . . . . . . . . . . . . . . . . . . . . . 46 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

CHAPTER 6 HEALTHCARE SYSTEMS O V E R V I E W . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Figure 6.1: Summary of healthcare system types and m-health trends . . . . . . . . . . . . . . . . . . . 49 Public healthcare markets . . . . . . . . . . . . . . 49 What are public healthcare markets? . . . . . . . . . . 49 M-health trends in public healthcare markets . . . 50 Private healthcare markets . . . . . . . . . . . . . . 50 What are private healthcare markets? . . . . . . . . . 50 M-health trends in private healthcare markets . . . 51 Unfunded healthcare markets. . . . . . . . . . . . 51 What are unfunded healthcare markets? . . . . . . . 51

M-health trends in unfunded healthcare markets: Africa . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Kiwanja case study . . . . . . . . . . . . . . . . . . . . 52 Ericsson case study . . . . . . . . . . . . . . . . . . . 53 CHAPTER 7 MOBILE HEALTHCARE IN A P U B L I C LY- F U N D E D M A R K E T: T H E U K ’ S N H S . . . . . . . . . . . . . . . . . . . . . . 55 Key points . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Market status . . . . . . . . . . . . . . . . . . . . . . . . . 55 Telecommunications services. . . . . . . . . . . . . . . . 56 Asset-tracking and lone worker protection services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Remote monitoring services . . . . . . . . . . . . . . . . . 57 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Market drivers . . . . . . . . . . . . . . . . . . . . . . . . 59 Figure 7.1: Key m-health market drivers . . . . 59

Market barriers . . . . . . . . . . . . . . . . . . . . . . . . 60 Figure 7.2: Key m-health market barriers . . . 60

Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 CHAPTER 8 MOBILE HEALTHCARE IN A P R I VAT E LY- F U N D E D M A R K E T: T H E U S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Key points . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Market status . . . . . . . . . . . . . . . . . . . . . . . . . 63 Operator overview . . . . . . . . . . . . . . . . . . . . . . . 63 Mobile billing . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Asset tracking . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Vendors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Health information management services . . . . . . 65 Market adoption . . . . . . . . . . . . . . . . . . . . . . . . . 65 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Market drivers . . . . . . . . . . . . . . . . . . . . . . . . 66 Figure 8.1: Key m-health market drivers . . . . 66

Market barriers . . . . . . . . . . . . . . . . . . . . . . . . 68 Figure 8.2: Key m-health market barriers . . . 68

Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 APPENDIX Selected mobile healthcare applications. . . . . . 72

ABOUT THE AUTHOR Philippa Hobbs is a Business Research Executive at Informa Telecoms & Media, specialising in mobile services and industry research. She has also produced events on mobile content and applications. Philippa holds a first class honours degree from the University of Bath and a Masters degree from City University London.

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